| Be it enacted by the People of the State of Maine as follows: |
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| | Sec. 1. 24-A MRSA §1912, as amended by PL 2003, c. 469, Pt. D, §3 | and affected by §9, is further amended to read: |
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| §1912. Standardized claim forms |
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| | All administrators who administer claims and who provide | payment or reimbursement for diagnosis or treatment of a | condition or a complaint by a licensed health care practitioner | must accept the current standardized claim form for professional | services approved by the Federal Government and submitted | electronically. All administrators who administer claims and who | provide payment or reimbursement for diagnosis or treatment of a | condition or a complaint by a licensed hospital must accept the | current standardized claim form for professional or facility | services, as applicable, approved by the Federal Government and | submitted electronically. An administrator may not be required | to accept a claim submitted on a form other than the applicable | form specified in this section and may not be required to accept | a claim that is not submitted electronically, except from a | health care practitioner who is exempt pursuant to Title 24, | section 2985. With the exception of claims for emergency room | services and pathology services, all claims for professional | services must be submitted on the standardized federal form used | by noninstitutional providers and suppliers to bill for Medicare | Part B covered services. |
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| | Sec. 2. 24-A MRSA §2436, sub-§2-A, as amended by PL 2003, c. 469, Pt. | D, §3 and affected by §9, is further amended to read: |
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| | 2-A. Except as provided in this subsection, for purposes of | this section, an "undisputed claim" means a timely claim for | payment of covered health care expenses under a policy or | certificate providing health care coverage that is submitted to | an insurer within 30 days of the date of service on the insurer's | standard claim form using the most current published procedural | codes with all the required fields completed with correct and | complete information in accordance with the insurer's published | claims filing requirements. After October 16, 2003 and until | October 16, 2005, for a provider with 10 or more full-time- | equivalent employees, an "undisputed claim" means a timely claim | for payment of covered health care expenses under a policy or | certificate providing health care coverage that is submitted to | an insurer, within 30 days of the date of service, in the | insurer's standard electronic data format using the most current | published procedural codes with all the required fields completed | with correct and complete information in accordance with the | insurer's published claims filing requirements. This |
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